Low Visceral Fat Area Research Articles

Clinical significance of obesity index (VFA versus BMI) as a risk factor for gastric cancer surgery.

139 Background: Obesity is considered as a major perioperative risk factor in various cancer surgeries. We aimed to elucidate the effect of two different obesity index, such as VFA (visceral fat area) and BMI (body mass index), on gastrectomy. Methods: From Mar 2009 to July 2010, 632 patients with diagnosed gastric carcinoma underwent curative gastrecomy at Seoul St. Mary’s hospital. We reviewed patients’ clinicopatholic data and collected 187 patients who had data including BMI, VFA and SFA. Patients with body mass index (BMI) ≥ 25 kg/m 2 were defined as obese and visceral fat area (VFA) ≥ 100 were defined as centrally obese. Results: Out of a total 187 patients, eighty patients were in the high BMI group and 107 patients were in the low BMI group. We selected patients with high VFA and low BMI (group A) and compared to the patients with low VFA and low BMI (group B). Out of a total 107 patients in low BMI, seventy three patients were censored as high VFA, and age older than 60 and male patients were prevalent in this group (p=0.045 and 0.046). The operation time (OT) and estimated blood loss (EBL) were significantly higher in group A than group B (p=0.043 and p=0.05). Conclusions: VFA and BMI are correlated each other and successfully represent patients’ obesity. However in selected patients, such as male patients with age older than sixty, VFA more practically represent their obesity.

Accumulation of visceral fat in maintenance hemodialysis patients

In hemodialysis (HD) patients, obesity has been recognized as a serious risk factor for mortality and morbidity for cardiovascular diseases. In addition, abnormalities of lipid profiles exist in these patients. In patients undergoing maintenance HD, incidences of abnormality of lipid profiles and visceral obesity determined by computed tomography scans were compared. In addition, the relationship between visceral fat area (VFA) and brachial-ankle pulse wave velocity (baPWV), an index of arterial stiffness, or carotid intima-media thickness (IMT), an index of atherosis, was examined. The incidence of high VFA (27.0%) was significantly greater than that of high body mass index (BMI) (9.7%), high low-density-lipoprotein cholesterol (LDL-C) (4.8%), and high triglyceride (12.7%). In patients with diabetes mellitus (DM), waist circumference and VFA showed a significant positive relationship with baPWV. baPWV was significantly higher in patients with high VFA and DM than in patients with low VFA without DM, those with high VFA without DM, and those with low VFA and DM. Carotid IMT was significantly greater in patients with high VFA and DM than in those with low VFA without DM and those with low VFA and DM. The incidence of high VFA was much greater than that of high BMI, high LDL-C, or high triglyceride. Visceral fat accumulation may be related to both arterial stiffness and atherosis in diabetic patients on maintenance HD.

Does visceral fat area (VFA) have predictive value for hypertension (HTN) and progression-free survival (PFS) in patients (pts) with stage IV NSCLC receiving bevacizumab (Beva)?

e18005 Background: Visceral fat releases pro-angiogenic factors that may promote tumour growth. VFA has been suggested as a predictor of outcome in colorectal and renal cancer pts receiving anti-VEGF agents (Guiu, Gut 2010; Ladoire, Oncologist 2011). Moreover, HTN seems to reflect the intensity of VEGF pathway inhibition, and could also predict outcomes in pts receiving Beva. We postulated that VFA could impact both the activity and toxicity of Beva. Methods: An electronical medical record review identified all pts with stage IV non-squamous NSCLC who received a platinum doublet plus Beva as first-line treatment in our outpatient unit. Beva was continued until disease progression or unacceptable toxicity in pts with response or stable disease after 6 cycles. VFA was determined from pre-treatment CT scans. HTN was monitored at home twice daily according to international guidelines, and graded according to the NCI-CTC v4.0 criteria. Pts were dichotomized according to their VFA (above or below the median), and potential associations linking VFA to HTN, PFS and OS were examined. Results: A total of 77 pts (65% males, 64% smokers, 36% with a PS of 2, median age: 57 years, range 38-86) were eligible for this analysis. Eighteen pts (23%) had a past history of HTN, well controlled at initiation of Beva. A total of 730 cycles of bevacizumab (median/pt: 6, range 2-22) were given. Grade ≥ 2 HTN was observed in 26 (34%) pts. At a median follow-up of 10.1 months (range: 1.0-35.3), the median PFS and OS were 6.9 months (95%CI: 5.6-8.6) and 10.6 months (95%CI: 9.8-11.7), respectively. Median VFA was 113.2 cm2 (range: 27.2-265.2). HTN was significantly more frequent in pts with a low VFA (46% vs. 21 %, OR 3.1, p = 0.03). Patients with a low VFA had a significantly longer PFS: 8.5 (95%CI: 6.4-9.4) vs. 5.6 months (95%CI: 4.8-7.5), p = 0.04. No difference was observed regarding OS. Conclusions: In this series of unselected NSCLC pts receiving bevacizumab-based chemotherapy, pts with a low VFA were more likely to experience HTN and a better PFS than pts with a high VFA. Further studies are required to validate this biomarker in different datasets.

Effect of obesity on intraoperative bleeding volume in open gastrectomy with D2 lymph-node dissection for gastric cancer.

BackgroundTo investigate the effect of obesity on open gastrectomy with D2 lymph-node dissection.MethodsBetween January 2005 and March 2007, 100 patients with preoperatively diagnosed gastric cancer who underwent open gastrectomy with D2 lymph-node dissection were enrolled in this study. Of these, 61 patients underwent open distal gastrectomy (ODG) and 39 patients underwent open total gastrectomy (OTG). Patients were classified as having a high body-mass index (BMI; ≥ 25.0 kg/m2; n = 21) or a normal BMI (<25.0 kg/m2; n = 79). The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed as identifiers of obesity using FatScan software. Patients were classified as having a high VFA (≥ 100 cm2; n = 34) or a normal VFA (<100 cm2; n = 66). The relationship between obesity and short-term patient outcomes after open gastrectomy was evaluated. Patients were classified as having high intraoperative blood loss (IBL; ≥ 300 ml; n = 42) or low IBL (<300 ml; n = 58). Univariate and multivariate analyses were used to identify predictive factors for high IBL.ResultsSignificantly increased IBL was seen in the following: patients with high BMI versus normal BMI; patients with gastric cancer in the upper third of the stomach versus gastric cancer in the middle or lower third of the stomach; patients who underwent OTG versus ODG; patients who underwent splenectomy versus no splenectomy; and patients with high VFA versus low VFA. BMI and VFA were significantly greater in the high IBL group than in the low IBL group. There was no significant difference in morbidity between the high IBL group and the low IBL group. Multivariate analysis revealed that patient age, OTG and high BMI or high VFA independently predicted high IBL.ConclusionIt is necessary to perform operative manipulations with particular care in patients with high BMI or high VFA in order to reduce the IBL during D2 gastrectomy.

Optimal waist circumference cutoffs for abdominal obesity in Chinese

Objective To determine the appropriate cutoffs for visceral fat area (VFA) measured by magnetic resonance imaging linking to risk of the metabolic syndrome (MetS) and the corresponding waist circumference in Chinese. Methods and results Totally 1140 individuals (men 525, women 615) aged from 35 to 75 years were included. The components of the MetS were defined by International Diabetes Federation (IDF) and Chinese Diabetes Society (CDS) definition, respectively. Receive operating characteristic curve analyses were used to determine the appropriate cutoffs of VFA and corresponding waist circumference in the prediction of the MetS. The optimal VFA cutoff was near 80 cm 2 in identifying the MetS with two or more components but not including overweight/obesity by either of the two definitions in all subjects. There was no difference in men by ages while women aged <50 years tended to have lower VFA cutoff than those aged ≥50 years by the two definitions. The appropriate waist circumference cutoffs were 90 cm in men and 85 cm in women for the MetS. Conclusion The optimal cutoff of waist circumference for abdominal obesity is 90 cm for men and 85 cm for women in Chinese.

Visceral fat accumulation determines postprandial lipemic response, lipid peroxidation, DNA damage, and endothelial dysfunction in nonobese Korean men

Visceral fat has been associated with multiple cardiovascular disease (CVD) risk factors. The aim of this study was to identify anthropometrical measures most closely associated with some well-known CVD risk factors. Because most Asians at risk have normal body mass index (BMI) according to Western standards, we studied healthy nonobese Korean males (n = 102; age: 36.5 +/- 0.8 years, BMI: 23.8 +/- 0.2 kg/m2). Visceral fat area (VFA) at the fourth lumbar vertebra was associated with increased postprandial triglyceride (TG) response (r = 0.53, P < 0.001) and with plasma malondialdehyde (MDA) (r = 0.36, P < 0.01) and PGF2alpha (r = 0.24, P < 0.05). When matched for BMI and age, men with high VFA (HVFA) (>/=100 cm2; n = 27) had higher blood pressure (P < 0.01), increased consumption of cigarettes (P < 0.01), and lower ratio of energy expenditure to calorie intake (P < 0.01) as compared with low VFA men (<100 cm2; n = 27). Men with HVFA showed higher TG, glucose, and insulin responses following fat and oral glucose tolerance tests respectively higher plasma concentrations of MDA (P < 0.001), urinary PGF2alpha (P < 0.05), and lymphocytes deoxyribonucleic acid tail moments (P < 0.01). Conversely, HVFA was associated with lower testosterone, insulin-like growth factor-1, and brachial artery flow-mediated dilation (P < 0.001). In conclusion, our data indicate that visceral fat accumulation, even in nonobese men, is a major factor contributing to increased CVD risk.

Two-hour insulin determination improves the ability of abdominal fat measurement to identify risk for the metabolic syndrome.

Visceral obesity is shown to be a predictor of morbidity and mortality. We evaluated the association of measurements of generalized adiposity and visceral fat area (VFA), with abnormalities of metabolic syndrome (MS). Seventy-six women (47.9 +/- 9.2 years) with BMI of 38.7 +/- 5.4 kg/m(2) underwent anthropometric measurements, laboratory procedures, bioeletrical impedance, and abdominal computed tomography (CT) scan. Diagnosis of MS was based on the presence of abdominal obesity and at least two of the following components: hypertension, dyslipidemia, and glucose intolerance and/or hyperinsulinemia. BMI was correlated with both components of adipose tissue--subcutaneous (r = 0.66, P < 0.01) and VFA (r = 0.33, P < 0.02)--and leptin levels (r = 0.38, P < 0.01). In contrast, VFA was correlated with 2-h glucose and insulin levels (r = 0.32 and 0.35, P < 0.05, respectively), triglyceride, HDL cholesterol, and uric acid (r = 0.33, -0.34 and 0.24, P < 0.05, respectively). Subjects with high VFA, matched for BMI, showed greater plasma glucose area under the curve (621 +/- 127 vs. 558 +/- 129 mg x h(-1) x dl(-1), P < 0.05), 2-h insulin (804 +/- 599 vs. 579 +/- 347 pmol/l, P < 0.05), and uric acid levels (0.33 +/- 0.07 vs. 0.26 +/- 0.06 mmol/l, P < 0.05) than subjects with low VFA. In logistic regression analysis, waist circumference, VFA, and 2-h insulin were identified as independent predictors of MS. Receiver operating characteristic curve analysis pointed out the values of 104 cm for waist circumference (58.1% specificity, 84.1% sensitivity), 158.5 cm(2) for VFA (78.1% specificity, 52.3% sensitivity), and 559.8 pmol/l for 2-h insulin (71.9% specificity, 69.8% sensitivity); the presence of at least two of the three variables resulted in a degree of concordance of 76%. While BMI was unable to differentiate between obese people and those at higher risk for MS, abdominal fat was shown to be associated with its metabolic abnormalities. The usefulness of abdominal fat in the identification of high-risk subjects may be improved when combined with 2-h insulin determination.

Molecular mechanism of vascular disease in metabolic syndrome X

Syndrome X is a clinical syndrome in which multiple risks are clustered in an individual and is a common basis of vascular disease in the industrial countries. However, the molecular basis of syndrome X has not been elucidated. We have analyzed body fat distribution using CT scanning and have shown that accumulated intra-abdominal visceral fat is frequently accompanied by multiple risks and vascular diseases. Thus, ‘‘visceral obesity’’ is a clinical entity compatible with syndrome X. Our studies demonstrated that the V/S ratio (visceral fat area, V/subcutaneous fat area, S) significantly correlated with the glucose area after oral glucose tolerance test (OGTT) and the plasma triglyceride or cholesterol level in obese subjects. Visceral fat accumulation is associated with not only quantitative change in serum lipid and lipoprotein but also qualitative changes in lipoproteins such as the appearance of small, dense LDL particles, which may be related to the high triglyceride–low HDL dyslipidemic state found in visceral fat obesity. Many people believe that insulin resistance or the hyperinsulinemic state that is often found in visceral fat obesity plays a key role in the development of metabolic disorders. Previous reports have shown that hyperinsulinemia, although not so predominant in Japanese subjects, is present in visceral type obesity. Studies using the glucose clamp technique by Kissebah et al. and our steady-state plasma glucose method clearly demonstrated that patients with visceral fat obesity have greater insulin resistance than those with subcutaneous fat obesity. Visceral fat accumulation has been shown to have causative effects in circulatory disorders in addition to metabolic disorders. We demonstrated a close correlation between the V/S ratio and the diastolic dimension index or stroke index in obese subjects that reflected the presence of a hypervolemic state in visceral fat obesity. There was a close correlation between systolic blood pressure and V/S ratio in premenopausal female subjects. As stated above, visceral fat obesity is characterized by high-risk obesity with multiple complications including insulin resistance, disorders of glucose and lipid metabolism, hypertension, and cardiac enlargement. We also demonstrated that the accumulation of visceral fat was related to the development of both metabolic disorders and circulatory disorders even in normal-weight subjects. Thus, a disease entity, ‘‘visceral fat syndrome,’’ can be proposed as a state that is accompanied frequently by glucose intolerance, hyperlipidemia, and hypertension irrespective of absolute body weight. Furthermore, several studies have shown that visceral adiposity determined by CT scanning is related to coronary artery disease (CAD). For example, according to our study on the fat distribution of 38 male patients with CAD, 9 cases were classified as obese with a BMI greater than 26.5 and 29 cases as non-obese. Eight of those nine obese subjects had extremely high V/S ratios compared with those of obese subjects without CAD. Among the non-obese subjects, the mean visceral fat area (VFA) in the patients with CAD was significantly larger than that of non-CAD controls. Thirtyeight percent of non-obese CAD subjects had VFAs greater than the mean ± 2 S.D. of the values obtained in non-CAD controls. The patients with high VFAs showed significantly higher levels of plasma glucose and insulin area after glucose ingestion than those with low VFAs, suggesting the presence of insulin resistance (Matsuzawa, 1997). The incidence of multiple risk factors including hyperlipidemia, hyperglycemia, and hypertension was higher in patients with high VFAs. These results together with previous reports indicate that visceral fat syndrome is a syndrome predisposing to susceptibility to atherosclerosis in which visceral fat accumulation often accompanies insulin resistance, glucose intolerance, hyperlipidemia, and hypertension, and the clustering of these risk factors may result in the occurrence of atherosclerosis. To clarify the molecular mechanism of the disorders in visceral fat syndrome, we analyzed the expressed genes in adipose tissue by large scale random sequencing. Unexpectedly, adipocytes, especially visceral adipocytes expressed a variety of the genes for secretory proteins including various bioactive substances and we designated